RA and Fatigue

Medically Reviewed by David Zelman, MD on February 12, 2024
5 min read



If you have rheumatoid arthritis and struggle with fatigue, you aren’t alone. It’s a common symptom of the disease.

Fatigue is much more than just being tired. It makes you feel like you’re totally out of energy. It can be so severe that you think you have the flu.

You might feel worn out even though you haven’t done more than usual. Often, nothing seems to help, not even sleep.

Fatigue can take a toll on your body, mind, and emotions. You may feel weary, foggy, or forgetful. It might be hard to enjoy get-togethers with friends or family.


Antibodies that cause the inflammation of RA affect your central nervous system, not just your joints. High inflammation levels can lead to severe fatigue.

RA also causes long-term pain. It can leave you feeling worn out by the end of the day. But when your joints hurt, it’s hard to sleep. RA fatigue makes it hard to feel refreshed when you wake up in the morning.


When you have RA, fatigue, pain, and mood problems can become a vicious cycle. Doctors think high levels of inflammation might cause all three of these symptoms.


You may need a mix of treatments, lifestyle changes, and a new attitude to keep fatigue under control.

Recognize that fatigue is a part of life with RA. You can’t always control it or predict when you’ll be too tired to work or join a social event. Listen to your body. You’ll feel better if you take the time to rest when you need to. Take breaks if you have a task that takes a lot of energy.

Tune out the guilt. Your friends and family may not really get how bad you feel. You aren’t lazy. You’re exhausted by your arthritis. Don’t feel guilty if you have to rest instead of going out or leave early because you’re too tired. Explain that fatigue is a symptom of your disease.

Don’t push yourself to keep up with everyone else. If you need help with household chores that exhaust you, ask others to give you a hand. Cut out any steps you don’t need to complete a task. Set your own pace. You decide what you can and can’t do on days when fatigue is high.

Get regular exercise. The last thing you may want to do is work out. But studies show that aerobic activity -- the kind that makes your heart beat faster -- cuts fatigue in people who have an immune system disorder like RA.

Exercise also strengthens the muscles around your joints, keeps your bones strong, and boosts your mood.

Start with a few minutes of brisk walking. Gradually work up to 30 minutes at least 5 times a week. Swimming or pool exercises are also good options, because the water is easy on your joints. Yoga and tai chi are two other gentle activities that help ease fatigue and lower stress.

Try to do something, even if it’s just stretching, on days when you’re really tired.

Take breaks.Don't stay in bed. It might make you feel more tired. Instead, take regular rest breaks during the day. Find times that fit in with your life. Do you get more done in the morning? Schedule some rest at noon. Do you need energy before the kids get home from school? Take a nap shortly before they get home.

Two or three short periods of downtime may give you the boost you need.

Fuel up with the right foods. Your body gets energy from the foods you eat. Choose fresh, whole items like fruits and veggies, lean protein, dairy products, and healthy fats. Omega-3 fatty acids, found in foods like nuts and cold-water fish, help ease fatigue by easing inflammation.

Little changes can make a big difference. Eat small, healthy meals throughout the day, so you don't feel sluggish. Go for snacks like an apple with peanut butter or tuna on whole-grain bread.

Is a cup of coffee your idea of breakfast? Choose foods that are rich in fiber, complex carbohydrates, and lean protein. A bowl of high-fiber cereal, fresh fruit, and low-fat milk can give you more energy for the rest of your day. Or try adding a hard-boiled egg, a cup of yogurt, or a banana to your morning.

Drink water. Your body needs fluids to keep going. Fatigue may be a sign that you’re dried out. Aim for about eight glasses a day. You may need more if you’re extra active or when it’s hot outside.

Stick to a sleep routine. Good habits help you get enough rest so you feel less fatigue the next day. Go to bed at the same time each night. Get up at the same time each morning. Cut back on caffeine, alcohol, and nicotine. All of these can disrupt your sleep.

When it’s time for lights-out, turn off devices like your smartphone or tablet. You’ll rest better in a dark, quiet room.

Seek counseling or therapy. Cognitive behavioral therapy or counseling with a mental health professional can ease the stress that worsens your fatigue. It can also help you control how fatigue affects your life.

Explore complementary treatments.Massage therapy often eases stress and anxiety. It helps you let go of your thoughts and get to sleep. Acupuncture also works for many people. Talk to your doctor before you take any herbal treatment or try any nonmedical therapy.

Talk to your doctor. If you've tried everything and still feel wiped out, let your doctor know. They can learn more about what the problem is.

It could be that you have anemia, which happens when you don't have enough red blood cells to carry oxygen around your body.

Anemia can start up because of long-term inflammation from RA or as a side effect of your medicines. Your doctor can check to see if you have it and get you started on treatment.

Other things that can also cause fatigue include:

  • Pain
  • Depression
  • Medication side effects
  • Weakness when you lose too much muscle
  • Infections